chapter 19 bites and stings

Chapter 19Bites and Stings

Animal Bites (1 of 2)

It is estimated that one of every two Americans will be bitten at some time by an animal or person.

• Dogs bites equal about 80% of these injuries.

•Immediate tissue damage and later infection are two concerns of animal bites.

© Chuck Stewart, MD.

Animal Bites (2 of 2)

• Children and elderly people are especially prone to animal bites.

• Damage mostly occurs on the hands, arms, legs, and face.

• Wild animal attacks occur most often in rural or wilderness locations.

Rabies (1 of 3)

• One of the most ancient and feared of diseases

Rabies (2 of 3)

• Caused by a virus found in warm-blooded animals• Spreads from one animal to another in

the saliva• A bite or scratch is considered exposure if it

penetrates the skin. • Nonbite exposure consists of contamination

of wounds.

Rabies (3 of 3)

• Consider an animal rabid if the animal:• Made an unprovoked attack • Acted strangely• Was a high-risk species

• Report animal bites to police or animal control.

Recognizing an Animal Bite• Puncture wound• Tissue and skin

crushed• Open wound on

fingers, knuckles, and/or hand

Care for Animal Bites• If the wound is not bleeding heavily, wash it

with soap and water. • Control the bleeding with direct pressure. • Cover the wound with sterile or clean

dressing. • Seek medical care.

Human BitesHuman bites can cause severe injury.•Most are acts of violence.•Most common injury location is the hand.

Recognizing Human Bites• True bites:

• Part of the body’s flesh is caught between teeth

• Clenched-fist injury:• Results from cutting a fist on teeth. • High likelihood of infection

Care for Human Bites• If the wound is not bleeding heavily, wash it

with soap and water for 5 to 10 minutes. • Flush with running water under pressure.• Control bleeding with direct pressure.• Cover with sterile dressing.

• Do not close the wound. • Seek medical care.

Snake Bites (1 of 7)

About 50,000 people throughout the world die of snake bites each year. In the United States 40,000 to 50,000 people are bitten by snakes, 7,000 to 8,000 of them by venomous snakes.

Snake Bites (2 of 7)

Four species of venomous snakes in the United States:• Rattlesnakes• Copperheads• Water moccasins• Coral snakes

Snake Bites (3 of 7)

• Snake bites can be painful, costly, and potentially deadly.

• Partial or complete loss of an extremity or finger or loss of movement in a joint can occur.

• Most victims recover.

Snake Bites (4 of 7)

• Rattlesnakes, copperheads, and water moccasins are pit vipers• Triangular, flat

heads • Elliptical pupils• A heat-sensitive pit

© AbleStock

Courtesy of Ray Rauch/U.S. Fish and Wildlife Services

Courtesy of South Florida Water Management District

Snake Bites (5 of 7)

• Coral snakes • Small and colorful• Series of bright red,

yellow, and black bands around its body

© Rolf Nussbaumer/age fotostock

Snake Bites (6 of 7)

• At least one species of venomous snake is found in every state except Alaska, Hawaii, and Maine.

Snake Bites (7 of 7)

Legitimate snake bite:• Bitten before the

encounter with a snake was recognized

• Bitten while trying to move away

• Most often involve the lower extremities

• Are accidental

Illegitimate snake bites:• Victim recognized the

encounter with a snake.• Did not attempt to move

away• Most often occur on the

upper extremities.• Most often occur when

the victim tries to kill, capture, play with, or move a snake.

Pit Vipers• Pit vipers are found in every state but

Alaska, Maine, and Hawaii.• Rattlesnakes are the most widespread. • Keep the rodent population under control

Recognizing Pit Viper Bites• Severe burning pain • Two small puncture

wounds• Swelling • Discoloration• Blood-filled blisters• Nausea, vomiting,

sweating, weakness

Care for Pit Viper Bites• Get victim away from snake.• Do not attempt to capture or kill the snake.• Keep victim quiet.• Gently wash area with soap and water.• Remove rings or other jewelry.• Stabilize the extremity.• Keep the extremity below heart level.• Seek medical care.

Coral Snake Bites• America’s most venomous snake• Rarely bite people• Venom is a neurotoxin• Symptoms begin 1 to 5 hours

after the bite.

Recognizing Coral Snake Bites• Minimal pain• Sagging or drooping upper eyelids• Weakness• Pricking, tingling of skin• Double vision• Difficulty swallowing• Sweating• Abnormal flow of saliva

Care for Coral Snake Bites• Keep victim calm.• Gently clean with soap and water.• Apply mild pressure.• Seek medical care.

Nonpoisonous Snake Bites

• Nonvenomous snakes inflict the most bites.

• Assume a snake is venomous if you don’t know what type it is.

Recognizing Nonpoisonous Snake Bites

• Mild to moderate pinch• Curved lines of tiny

pinpricks on the skin that correspond with the rows of sharp, pointy teeth

• Bleeding• Mild itching

Care for Nonpoisonous Snake Bites

• Gently clean with soap and water.

• Care for the bite as you would a minor wound.

• Seek medical care.

Insect Stings (1 of 2)

• Honeybees• Bumblebees• Yellow jackets• Hornets• Wasps• Fire ants

© Borut Gorenjak/ShutterStock, Inc.© Dwight Lyman/ShutterStock, Inc.

© pixelman/ShutterStock, Inc.© Heintje Joseph T. Lee/ShutterStock, Inc.

Insect Stings (2 of 2)

• These insects account for more deaths and illnesses each year than all other venomous animals combined.

• About 1 in every 200 people is dangerously allergic to stinging insect venom.

Insect StingsHoneybees and Some Yellow Jackets• Have barbed stingers.• Barbed stingers become embedded in

the victim’s skin during the sting.• Die after the sting

Insect StingsHoneybees and Bumblebees

• Do not release all their venom during initial injection

• Some venom remains in the stinger embedded in the victim’s skin.

• This venom worsens the victim’s reaction.

Insect StingsWasps, Yellow Jackets, Hornets, and Fire

Ants• Stingers are not

barbed.• Stingers do not

embed in victim• Can sting multiple

times• Most do not die

after stingingCourtesy of Scott Bauer/USDA

Insect StingsYellow Jackets

• Wasp• Can sting multiple times

• Ground-nesting bee• Stings once then dies• Smaller than yellow jacket wasps

Reactions to Insect Stings (1 of 2)

Most stings cause only self-limited, local inflammatory reactions. •Pain•Itching•Redness•Swelling

Courtesy of Daniel Wojcik/USDA

Reactions to Insect Stings (2 of 2)•Swelling and redness•Nausea•Vomiting•Wheezing•Fever

• Drippy nose• Anaphylaxis

• Generally occurs within few minutes to 1 hour

• Throat swelling• Bronchospasm

Multiple Insect Stings• Five hundred stings will usually kill even

people who are not allergic to stinging insects.

• Massive numbers of stings are rare. • Africanized bees are also known as killer

bees.

Recognizing Insect Stings (1 of 2)• Usual reactions:

• Instant pain• Redness at site• Itching

• Worrisome reactions:• Hives• Swelling of lips or

tongue• Tickle in throat• Wheezing

• Life-threatening reactions:• Bluish or grayish

skin color• Seizures• Unresponsiveness• Inability to breathe

Recognizing Insect Stings (2 of 2)

• Lack of uniformity in victims’ responses • Stings to the mouth or eye tend to be more

dangerous.• Victims tend to react more severely to

multiple stings, especially 10 or more.• The most dangerous single stings in

nonallergic individuals are those inside the throat.

Care for Insect Stings• Remove stinger and venom sac.• Wash with soap and water.• Apply an ice pack.• Give pain medication, topical steroid

cream, or antihistamine.• Observe the victim for 30 minutes. • Only use epinephrine for severe allergic

reaction• Watch for delayed allergic reaction

Spider and Insect Bites• Most spiders are

venomous, but most lack long fangs and strong jaws to bite a human.

• About 60 species of spiders in North America are capable of biting humans.

Black Widow Spiders (1 of 2)

• Also known as brown widow spiders and red-legged spiders

• Only three of the five species are actually black

© photobar/ShutterStock, Inc.

Black Widow Spiders (2 of 2)

• Females are one of the largest spiders• Fangs can penetrate human skin• Shiny black abdomens with red or yellow spot

or white spots or bands• Produce one of the most potent venoms• Found throughout world• Extensive, irregular, shaggy web

Recognizing Black Widow Spider Bites

• Victim might feel a sharp pinprick• Two tiny red spots might be seen • Within 15 minutes to 4 hours, muscle

stiffness and cramps occur. • Headache, chills, fever, sweating,

dizziness, nausea, and vomiting• Severe pain around bite peaks in 2 to 3

hours

Care for Black Widow Spider Bites

• Catch spider if possible.• Clean with soap and water or rubbing

alcohol.• Place an ice pack over the bite.• Give pain medication.• Monitor breathing.• Seek medical care immediately.

Brown Recluse Spiders• Also known as fiddle-

back and violin spiders in North America

• Violin-shape on back• Fawn to dark brown • Male and female are

venomous• Primarily in the

southern and midwestern states

Courtesy of Kenneth Cramer, Monmouth College

Recognizing Brown Recluse Spider Bites

• Local reaction usually within 2 to 8 hours• Mild to severe pain at the bite site• Redness, swelling, and local itching• Blister forms at site in 48 to 72 hours

• Bull’s-eye pattern• Volcano lesions

• Fever, weakness, vomiting, joint pain, rash• Stomach cramps, nausea, vomiting

Care for Brown Recluse Spider Bites

• Catch spider if possible.• Clean with soap and water or

rubbing alcohol.• Apply an ice pack.• Give pain medication.• Seek medical care immediately.

Tarantulas• Bite only when

provoked or roughly handled

• When upset, scratches abdomen and flicks hairs onto a person

© Nick Simon/ShutterStock, Inc.

Recognizing Tarantula Bites and Embedded Hairs

• The bite causes pain, aching, or stinging.

• The hairs cause itching and inflammation that can last several weeks.

Care for Tarantula Bites• Catch spider if possible.• Clean with soap and water or rubbing alcohol.• Apply an ice pack.• Give pain medication.• Seek medical care immediately.

Care for Embedded Tarantula Hairs

• Remove hairs with sticky tape.• Wash with soap and water.• Apply hydrocortisone cream.• Give the victim pain medication.• Give the victim an antihistamine.

Recognizing Common Aggressive House Spider

Bites• Similar to those of the brown recluse

spider• Redness, blisters, and later, dead

tissue• Headache, visual problems, weakness

Care for Common Aggressive House Spider

Bites• Catch spider if possible.• Clean with soap and water or

rubbing alcohol.• Apply an ice pack.• Give pain medication.• Seek medical care immediately.

Scorpion Stings (1 of 2)

• Look like miniature lobsters• Pincers and long,

up-curved taillike appendage with poisonous stinger

© David Desoer/ShutterStock, Inc.

Scorpion Stings (2 of 2)

• Bark scorpion is the only threat to humans.• Found primarily in Arizona • Pale tan color• Three fourths of an inch to 1.25 inches long

• Stings to adults are usually not life-threatening.

• Stings to small children may be dangerous.

Recognizing Scorpion Stings• Local immediate pain and burning• Later, numbness or tingling• No swelling or blanching• Tapping finger over site causes pain.• Pain or even paralysis in severe cases• Uncontrolled jerking movements and facial

twitching

Care for Scorpion Stings• Monitor breathing.• Gently clean with soap and water or

rubbing alcohol.• Apply an ice pack.• Give pain medication.• Seek medical care.

Centipede Bites• Giant desert centipede is only US

centipede dangerous to humans.• Up to 8 inches long• Can inject toxic substances • Venom is relatively weak

Recognizing Centipede Bites• Burning pain• Local inflammation• Mild swelling of lymph nodes• Inflammation, swelling, redness lasting 4-12

hours• Swelling and tenderness can last 3 weeks,

or disappear and recur.

Care for Centipede Bites• Clean the wound with soap and water.• Apply an ice pack. • Give pain medication. • Seek medical care for severe reactions.

Mosquito Bites• In developing countries,

mosquitoes transmit malaria, yellow fever, dengue fever.

• In the United States, they carry encephalitis.

• Need blood to lay eggs• Breed in water• Most bite at twilight

Care for Mosquito Bites• Wash with soap and water.• Apply an ice pack.• Apply calamine lotion or hydrocortisone

ointment.• Antihistamine every 6 hours or cortisone

might be useful

Embedded Ticks (1 of 2)

• Close relatives of mites and spiders • Classified as hard ticks or soft ticks• Carry diseases, are nuisance, cause

paralysis• Need blood meal to grow • Limited in ability to find meals• Bites are nearly painless

Embedded Ticks (2 of 2)

• Front part consists of the head area and the mouthparts• Hypostome• Barbs

• Most tick bites are harmless.

Care for Embedded Ticks• Use tweezers or

specialized tick removal tool

• Grasp tick as close to skin as possible.

• Lift with enough force to tent the skin

• Hold until tick lets go • Do not pull hard

enough to break the tick apart.

Care for Embedded TicksAfter Removal (1 of 2)

• Wash with soap and water. • Apply rubbing alcohol.• Apply an ice pack.• Apply calamine lotion. • Keep the area clean.• Watch bite site for rash for 1 month.

Care for Embedded TicksAfter Removal (2 of 2)

• Seek medical care if:• Rash• Fever• Muscle aches• Sensitivity to light• Paralysis begins

with leg weaknessCourtesy of James Gathany/CDC

Marine Animal Injuries

• Most marine animals bite or sting in defense, rather than attack.

Sharks

• The chance of being attacked by a shark along the North American coastline is less than 1 in 5 million.

• Most attacks occur within 100 feet of shore.• Most victims are attacked without warning. • The leg is the most frequently bitten part.• Sharks are attracted to chemicals found in fish

blood.

Recognizing a Shark Bite• Severe bleeding• Large, open wounds,

most often on legs• Abrasions from

contact with sharkskin

© AbleStock

Care for a Shark Bite or Puncture

• Control bleeding.• Treat for shock.• Seek medical care.

Barracudas and Moray Eels• Barracuda bites are rare.• Moray eels are frequent

biters of divers who handle or tease them.

Recognizing Barracuda and Moray Eel Bites

• Barracuda lacerations are similar to those of a shark.

• Eel bites involve severe puncture wounds with narrow jaws.

Care for Barracuda and Moray Eel Bites

• Care for a barracuda bite as you would a shark bite.

• Care for an eel bite:• Flush the wound with water under

pressure.• Control the bleeding.

Marine Animals That Sting• Each year, jellyfish, Portuguese man-of-wars,

corals, and anemones that lie along the shallow ocean waters of the United States sting more than 1 million people.

• Jellyfish and Portuguese man-of-wars have long tentacles equipped with stinging devices called nematocysts.

Portuguese Man-of-War Sting• Well-defined linear

welts or scattered patches of welts with redness

• Usually disappear within 24 hours

Courtesy of NOAA

Jellyfish Sting• Produces severe

muscle cramping • Multiple, thin lines of

welts in a zigzag pattern

• Burning type pain• Welts disappear within

an hour. © Nir Levy/ShutterStock, Inc.

Anemone Sting• Potentially

dangerous• Result from

improper handling

© Roger Dale Calger/ShutterStock, Inc.

Recognizing Marine Animal Stings

• Stinging• Severe itching and burning• Prickling, tingling• Blisters• Severe allergic reaction• Difficulty breathing• Muscle cramping• Nausea, vomiting

Care for Marine Stings• Apply vinegar for at least 30 seconds.

• Baking soda paste will work too.• Use hot water immersion for at least 20

minutes. • Hot dry pack will work too.

• Apply a coating of hydrocortisone several times a day.

Stingrays• Most wounds inflicted by stingrays are

produced on the ankle or foot when the victim steps on the ray.

• At least 1,500 stingray injuries occur each year in coastal US waters.

• The tail barb of a stingray easily penetrates human skin.

Recognizing a Stingray Puncture

• Sudden, intense pain• Open wound• Swelling

© AbleStock

Care for a Stingray Puncture• Immerse the injured part in hot

water for 30 to 90 minutes.• Wash the wound with soap and

water.• Irrigate with water under pressure.• Treat like any puncture wound.